Öz
The primary objective of this review is to provide a concise summary and critical appraisal of the current literature on the differential diagnosis and management of hypocalcemia. Calcium plays a crucial role in muscle function and neurotransmitter release. However, hypocalcemia, defined as serum calcium levels below 8 mg/dL (2.12 mmol/L), can affect various organs and systems and lead to a range of clinical symptoms. This condition can range from being completely asymptomatic to life-threatening situations.
Disorders responsible for hypocalcemia can be divided into two groups: those influenced by parathyroid hormone (PTH) and those not affected. In non-surgical and PTH-mediated forms, more comprehensive investigation is necessary to identify the underlying cause and determine appropriate treatment.
In cases of acute hypocalcemia, intravenous calcium infusion is required to rapidly increase calcium levels and correct symptoms. On the other hand, treatment of chronic hypocalcemia generally involves oral calcium and/or vitamin D supplementation.
In conclusion, this review specifically emphasizes iatrogenic (treatment-related) hypocalcemia while assessing the causes, dimensions, and management of hypocalcemia in cancer patients. Physicians' familiarity with these conditions is crucial in treatment management.
Anahtar Kelimeler
Hypocalcemia hypomagnesemia cancer treatment chemotherapy cisplatin
Etik Beyan
derleme olduğu için etik kurul başvurusu olmamıştır.
Destekleyen Kurum
Destekleyen kurum yoktur.
Kaynakça
- 1. Pepe J, Colangelo L, Biamonte F, et al. Diagnosis and management of hypocalcemia. Endocrine 2020;69:485-495. https://doi.org/10.1007/s12020-020-02324-2
- 2. Guise TA, Wysolmerski JJ. Cancer-associated hypercalcemia. NEJM 2022;386:1443-1451. https://doi.org/10.1056/NEJMcp2113128
- 3. Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013;28:166-177. https://doi.org/10.1177/0885066611411543
- 4. Bove Fenderson E, Mannstadt M. Hypocalcemic disorders. Best Prac Res Clin Endocrinol Metab 2018;32:639-656. https://doi.org/10.1016/j.beem.2018.05.006
- 5. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ 2008;336:1298-1302. https://doi.org/10.1136/bmj.39582.589433.BE
- 6. Lechner M, Moghul G, Chandrasekharan D, et al. Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust. BMJ Open Qual 2023;12:e001190. https://doi.org/10.1136/bmjoq-2020-001190
- 7. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypocalcemia. J Bone Miner Metab 2009;27:635-642. https://doi.org/10.1007/s00774-009-0119-x
- 8. Alıcı S, Çekici S. Malign hastalıklarda bisfosfonatların rolü. Van Med J 2002;9:66-72.
- 9. Pittman K, Antill YC, Goldrick A, Goh J, de Boer RH. Denosumab: prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures. Asia Pac J Clin Oncol 2017;13:266-276. https://doi.org/10.1111/ajco.12517
- 10. Cummings SR, Rosen C. VITAL findings-a decisive verdict on vitamin D supplementation. NEJM 2022;387:368-370. https://doi.org/10.1056/NEJMe2205993
- 11. Crotti C, Watts NB, De Santis M, et al. Acute phase reactions after zoledronic acid infusion: protective role of 25-hydroxyvitamin D and previous oral bisphosphonate therapy. Endocr Pract 2018;24:405-410. https://doi.org/10.4158/EP161638.OR
- 12. Huang SY, Yoon, SS, Shimizu K, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, randomized controlled phase 3 study-Asian subgroup analysis. Adv Ther 2020;37:3404-3416. https://doi.org/10.1007/s12325-020-01395-x
- 13. Tsvetov G, Amitai O, Shochat T, Shimon I, Akirov A, Diker Cohen T. Denosumab-induced hypocalcemia in patients with osteoporosis: can you know who will get low? Osteoporos Int 2020;31:655-665. https://doi.org/10.1007/s00198-019-05261-7
- 14. Soytaş RB, Avci S, Yavuzer H, Ozkok S, Doventas A, Erdincler DS. 65 yaş üstü osteoporoz hastalarında denosumab ve zoledronik asitin yan etkilerinin karşılaştırılması. GTD 2021;31:135-139. https://doi.org/10.15321/GenelTipDer.2021.300
- 15. Joseph A, Lafarge A, Azoulay E, Zafrani L. Acute kidney injury in cancer immunotherapy recipients. Cells 2002;11:3991. https://doi.org/10.3390/cells1124399
- 16. Manohar S, Kompotiatis P, Thongprayoon C, Cheungpasitporn W, Herrman J, Herrmann SM. Programmed cell death protein 1 inhibitor treatment is associated with acute kidney injury and hypocalcemia: meta-analysis. Nephrol Dial Transplant 2019;34:108-117. https://doi.org/10.1093/ndt/gfy105
- 17. Uppal NN, Workeneh BT, Rondon Berrios H, Jhaveri KD. Electrolyte and acid-base disorders associated with cancer immunotherapy. Clinic Am Soc Nephrol 2022;17:922-933. https://doi.org/10.2215/CJN.14671121
- 18. Tharmalingam S, Reddy S, Sharda P, Koch CA. Severe hypocalcemia and transient hypoparathyroidism after hyperthermic intraperitoneal chemotherapy. Horm Metab Res 2020;52:689-690. https://doi.org/10.1055/a-1220-6971
- 19. Hu J, Wang Z, Wang X, Xie S. Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers. PeerJ 2023;11:e15277. https://doi.org/10.7717/peerj.15277
- 20. Cohen PR, Prieto VG, Kurzrock R. Tumor lysis syndrome: introduction of a cutaneous variant and a new classification system. Cureus 2021;13:e13816. https://doi.org/10.7759/cureus.13816
- 21. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. NEJM 2011;364:1844-1854. https://doi.org/10.1016/B978-0-12-415948-8.00004-0 22. Hüzmeli, C. Assessment of tumor lysis syndrome cases. CMJ 2019;41:28-33. http://dx.doi.org/10.7197/223.vi.460369
- 23. Calvo Villas JM. Tumour lysis syndrome. Med Clin (Barc) 2019;152:397-404. https://doi.org/10.1016/j.medcli.2018.10.029
- 24. Vodopivec DM, Rubio JE, Fornoni A, Lenz O. An unusual presentation of tumor lysis syndrome in a patient with advanced gastric adenocarcinoma: case report and literature review. Case Rep Med 2012;2012:468452. https://doi.org/10.1155/2012/468452
- 25. Eren E, Ata A, Arıcan A. Kanser tedavisinde kullanılan ilaçlar ve nefrotoksisite. DEÜ Tıp Fakültesi Dergisi 2012;26:229-235.
- 26. Kömürcüoğlu B, Büyükşirin M, İşgüder H, Kalenci D, Özden E. Cisplatin uygulanan akciğer Ca’lı hastalarda serum magnezyum ve kalsiyum düzeylerinin monitorizasyonu gerekli midir? İzmir Göğüs Hastanesi Dergisi 2004;18:101-106.
- 27. Nicholas J, Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynould’s Phenomenon in patients with cisplatin, vinblastine, and bleomycin. Cancer 1985;56:2765-2770. https://doi.org/10.1002/1097-0142(19851215)56:12<2765::aid-cncr2820561208>3.0.co;2-2
- 28. Izzedine H, Perazella MA. Adverse kidney effects of epidermal growth factor receptor inhibitors. Nephrol Dial Transplant 2017;32:1089-1097. https://doi.org/10.1093/ndt/gfw467
- 29. De Leo S, Trevisan M, Colombo C, Moneta C, Giancola N, Fugazzola L. Hypocalcemia during lenvatinib treatment for advanced thyroid cancer: clinical features and management in a real-life setting. Thyroid 2023;33:74-81. https://doi.org/10.1089/thy.2022.0439
- 30. Hu MI, Elisei R, Dedecjus M, et al. Safety and efficacy of two starting doses of vandetanib in advanced medullary thyroid cancer. Endocr Relat Cancer 2019;26:241-250. https://doi.org/10.1530/ERC-18-0258
Öz
Bu derlemenin temel amacı, hipokalseminin ayırıcı tanısı ve yönetimi ile ilgili mevcut literatürün kısa bir özetini ve eleştirel bir değerlendirmesini sunmaktır. Kalsiyum, kas fonksiyonu ve nörotransmitter salınımında önemli bir rol oynar. Bununla birlikte, 8 mg/dL'nin (2,12 mmol/L) altındaki serum kalsiyum seviyeleri olarak tanımlanan hipokalsemi, çeşitli organ ve sistemleri etkileyebilir ve çeşitli klinik belirtilere yol açabilir. Bu tablo tamamen asemptomatik olabileceği gibi hayatı tehdit eden durumlara da yol açabilir.
Hipokalsemiden sorumlu bozukluklar iki gruba ayrılabilir: paratiroid hormonundan (PTH) etkilenenler ve etkilenmeyenler. Cerrahi nedenlerden kaynaklanmayan ve PTH aracılı olmayan formlarda, altta yatan nedeni tanımlamak ve uygun tedaviyi belirlemek için daha kapsamlı bir araştırma gereklidir.
Akut hipokalsemi vakalarında, intravenöz kalsiyum infüzyonu kalsiyum seviyelerini hızla artırmak ve semptomları düzeltmek gereklidir. Öte yandan, kronik hipokalsemi tedavisinde oral kalsiyum ve/veya D vitamini takviyesi genellikle yeterlidir.
Sonuç olarak, bu derleme kanser hastalarında hipokalseminin nedenlerini, boyutlarını ve yönetimini değerlendirirken tedavi ilişkili (iatrojenik) hipokalsemiye özellikle vurgu yapmaktadır. Hekimlerin bu durumları iyi tanıması tedavi yönetiminde önemlidir.
Anahtar Kelimeler
Hipokalsemi hipomagnezemi kanser tedavisi kemoterapi sisplatin
Kaynakça
- 1. Pepe J, Colangelo L, Biamonte F, et al. Diagnosis and management of hypocalcemia. Endocrine 2020;69:485-495. https://doi.org/10.1007/s12020-020-02324-2
- 2. Guise TA, Wysolmerski JJ. Cancer-associated hypercalcemia. NEJM 2022;386:1443-1451. https://doi.org/10.1056/NEJMcp2113128
- 3. Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013;28:166-177. https://doi.org/10.1177/0885066611411543
- 4. Bove Fenderson E, Mannstadt M. Hypocalcemic disorders. Best Prac Res Clin Endocrinol Metab 2018;32:639-656. https://doi.org/10.1016/j.beem.2018.05.006
- 5. Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ 2008;336:1298-1302. https://doi.org/10.1136/bmj.39582.589433.BE
- 6. Lechner M, Moghul G, Chandrasekharan D, et al. Preoperative and postoperative optimisation of patients undergoing thyroid surgery: a multicentre quality improvement project at Barts Health NHS Trust. BMJ Open Qual 2023;12:e001190. https://doi.org/10.1136/bmjoq-2020-001190
- 7. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypocalcemia. J Bone Miner Metab 2009;27:635-642. https://doi.org/10.1007/s00774-009-0119-x
- 8. Alıcı S, Çekici S. Malign hastalıklarda bisfosfonatların rolü. Van Med J 2002;9:66-72.
- 9. Pittman K, Antill YC, Goldrick A, Goh J, de Boer RH. Denosumab: prevention and management of hypocalcemia, osteonecrosis of the jaw and atypical fractures. Asia Pac J Clin Oncol 2017;13:266-276. https://doi.org/10.1111/ajco.12517
- 10. Cummings SR, Rosen C. VITAL findings-a decisive verdict on vitamin D supplementation. NEJM 2022;387:368-370. https://doi.org/10.1056/NEJMe2205993
- 11. Crotti C, Watts NB, De Santis M, et al. Acute phase reactions after zoledronic acid infusion: protective role of 25-hydroxyvitamin D and previous oral bisphosphonate therapy. Endocr Pract 2018;24:405-410. https://doi.org/10.4158/EP161638.OR
- 12. Huang SY, Yoon, SS, Shimizu K, et al. Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, randomized controlled phase 3 study-Asian subgroup analysis. Adv Ther 2020;37:3404-3416. https://doi.org/10.1007/s12325-020-01395-x
- 13. Tsvetov G, Amitai O, Shochat T, Shimon I, Akirov A, Diker Cohen T. Denosumab-induced hypocalcemia in patients with osteoporosis: can you know who will get low? Osteoporos Int 2020;31:655-665. https://doi.org/10.1007/s00198-019-05261-7
- 14. Soytaş RB, Avci S, Yavuzer H, Ozkok S, Doventas A, Erdincler DS. 65 yaş üstü osteoporoz hastalarında denosumab ve zoledronik asitin yan etkilerinin karşılaştırılması. GTD 2021;31:135-139. https://doi.org/10.15321/GenelTipDer.2021.300
- 15. Joseph A, Lafarge A, Azoulay E, Zafrani L. Acute kidney injury in cancer immunotherapy recipients. Cells 2002;11:3991. https://doi.org/10.3390/cells1124399
- 16. Manohar S, Kompotiatis P, Thongprayoon C, Cheungpasitporn W, Herrman J, Herrmann SM. Programmed cell death protein 1 inhibitor treatment is associated with acute kidney injury and hypocalcemia: meta-analysis. Nephrol Dial Transplant 2019;34:108-117. https://doi.org/10.1093/ndt/gfy105
- 17. Uppal NN, Workeneh BT, Rondon Berrios H, Jhaveri KD. Electrolyte and acid-base disorders associated with cancer immunotherapy. Clinic Am Soc Nephrol 2022;17:922-933. https://doi.org/10.2215/CJN.14671121
- 18. Tharmalingam S, Reddy S, Sharda P, Koch CA. Severe hypocalcemia and transient hypoparathyroidism after hyperthermic intraperitoneal chemotherapy. Horm Metab Res 2020;52:689-690. https://doi.org/10.1055/a-1220-6971
- 19. Hu J, Wang Z, Wang X, Xie S. Side-effects of hyperthermic intraperitoneal chemotherapy in patients with gastrointestinal cancers. PeerJ 2023;11:e15277. https://doi.org/10.7717/peerj.15277
- 20. Cohen PR, Prieto VG, Kurzrock R. Tumor lysis syndrome: introduction of a cutaneous variant and a new classification system. Cureus 2021;13:e13816. https://doi.org/10.7759/cureus.13816
- 21. Howard SC, Jones DP, Pui CH. The tumor lysis syndrome. NEJM 2011;364:1844-1854. https://doi.org/10.1016/B978-0-12-415948-8.00004-0 22. Hüzmeli, C. Assessment of tumor lysis syndrome cases. CMJ 2019;41:28-33. http://dx.doi.org/10.7197/223.vi.460369
- 23. Calvo Villas JM. Tumour lysis syndrome. Med Clin (Barc) 2019;152:397-404. https://doi.org/10.1016/j.medcli.2018.10.029
- 24. Vodopivec DM, Rubio JE, Fornoni A, Lenz O. An unusual presentation of tumor lysis syndrome in a patient with advanced gastric adenocarcinoma: case report and literature review. Case Rep Med 2012;2012:468452. https://doi.org/10.1155/2012/468452
- 25. Eren E, Ata A, Arıcan A. Kanser tedavisinde kullanılan ilaçlar ve nefrotoksisite. DEÜ Tıp Fakültesi Dergisi 2012;26:229-235.
- 26. Kömürcüoğlu B, Büyükşirin M, İşgüder H, Kalenci D, Özden E. Cisplatin uygulanan akciğer Ca’lı hastalarda serum magnezyum ve kalsiyum düzeylerinin monitorizasyonu gerekli midir? İzmir Göğüs Hastanesi Dergisi 2004;18:101-106.
- 27. Nicholas J, Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynould’s Phenomenon in patients with cisplatin, vinblastine, and bleomycin. Cancer 1985;56:2765-2770. https://doi.org/10.1002/1097-0142(19851215)56:12<2765::aid-cncr2820561208>3.0.co;2-2
- 28. Izzedine H, Perazella MA. Adverse kidney effects of epidermal growth factor receptor inhibitors. Nephrol Dial Transplant 2017;32:1089-1097. https://doi.org/10.1093/ndt/gfw467
- 29. De Leo S, Trevisan M, Colombo C, Moneta C, Giancola N, Fugazzola L. Hypocalcemia during lenvatinib treatment for advanced thyroid cancer: clinical features and management in a real-life setting. Thyroid 2023;33:74-81. https://doi.org/10.1089/thy.2022.0439
- 30. Hu MI, Elisei R, Dedecjus M, et al. Safety and efficacy of two starting doses of vandetanib in advanced medullary thyroid cancer. Endocr Relat Cancer 2019;26:241-250. https://doi.org/10.1530/ERC-18-0258
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | İç Hastalıkları |
| Bölüm | Derleme |
| Yazarlar | |
| Erken Görünüm Tarihi | 12 Mart 2024 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 26 Aralık 2023 |
| Kabul Tarihi | 4 Mart 2024 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 17 Sayı: 3 |
Kaynak Göster
